引用本文:赵斌,冯芃,赵巍巍,等.美国医疗保障制度改革的先行者——马萨诸塞州医改综述[J].中国卫生政策研究,2013,6(11):60-65 |
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美国医疗保障制度改革的先行者——马萨诸塞州医改综述 |
投稿时间:2013-08-26 修订日期:2013-11-11 PDF全文浏览 HTML全文浏览 |
赵斌1, 冯芃2, 赵巍巍3 4, 梁海伦5 |
1. 人力资源和社会保障部社会保障研究所 北京 100029 2. 中国银行甘肃省分行 甘肃兰州 730000 3. 北京劳动保障职业学院 北京 100029 4. 北京大学社会学系 北京 100871 5. 约翰霍普金斯大学彭博公共卫生学院 美国马里兰州巴尔的摩 21205 |
摘要:马萨诸塞州2006年医改被视为2010年奥巴马美国医改的原型和模板,研究马州医改进展和效果,有助于推断美国医改可能取得的成绩及问题。2006年马州医改主要通过以下方式扩大医疗保险覆盖范围,提高医疗服务可及性。一是增加政府投入,扩大面向低收入人群的马州医疗援助计划覆盖范围,新建资助中低收入人群参保的公民健康保障计划,从而提高中低收入人群的参保能力;二是新建医疗保险交易局管理新建计划,干预私营医疗保险市场,新建致力于医疗保险标准化、面向高收入人群的公民健康选择计划;三是强制个人参保,要求雇主为雇员提供保险。综合现有文献,马州医改已取得许多成就,但也存在一定问题。一方面,无保障人群数量不断缩小,居民医疗服务可及性提高,可负担性也有所改进;另一方面,医疗支出快速上升影响了改革的可持续性,制度设计的一些缺陷影响了部分人群的医疗服务可及性,同时安全网计划资金的消减也可能影响医改效果。我国可借鉴马州经验建立商业健康保险管制机构,促进我国商业健康保险市场发展;同时需准备面对全民医保覆盖后的医疗费用快速增长问题,还需警惕全面覆盖后的“参保却不享有”问题。 |
关键词:卫生改革 医疗保险 医疗费用 可及性 |
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A pioneer of healthcare reform in the United States:A review of health care reform in Massachusetts |
ZHAO Bin1, FENG Peng2, ZHAO Wei-wei3 4, LIANG Hai-lun5 |
1. National Institution for Social Security Research, Ministry of Human Resource and Social Security, Beijing 100029,China 2. Gansu Province branch, Bank of China, Gansu Lanzhou 730000, China 3. Beijing Vocational College of Labor Security, Beijing 100029, China 4. Department of Sociology, Peking University, Beijing 100871, China 5. Bloomberg School of Public Health, Johns Hopkins University, Baltimore 21205, USA |
Abstract:Healthcare reform in Massachusetts in 2006 is a prototype of the Affordable Care Act 2010. Reviewing healthcare reform in Massachusetts can help predicate the outcomes of healthcare reform across the whole of the United States. Healthcare for uninsured people is the main target of Massachusetts healthcare reform. Several measures were taken to achieve this goal. First, government subsidies were raised; health insurance coverage was expanded; and premium subsidy schemes for the low-income population was established. These improved the ability of low- and middle-income people to purchase health insurance. Second, an exchange was established to regulate the private health insurance market, and contracts-standardization schemes were established for the high-income population. Third, individuals were mandated to purchase health insurance, and employers were required to provide health insurance for their employees. The literature shows that the reforms had great achievements, but there were also several problems. On the one hand, the number of uninsured people was reduced, and the accessibility and affordability of healthcare increased. On the other hand, sustainability of reform is threatened by rocketing health expenditure; accessibility of healthcare for some people is reduced; and the budget for a safety net program is insufficient and threatens the sustainability of the system. China should learn from the experience of Massachusetts, establish a health insurance exchange to regulate commercial health insurance market, and rocketing healthcare expenses after universal coverage. China is also supposed to prepare a solution for the "insured cannot enjoy benefit" problem. |
Key words:Health care reform Health insurance Medical expenditure Accessibility |
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